Guidelines of Clinical Practice for the Management of Swallowing Disorders and Recent Dysphonia in the Context of the COVID-19 Pandemic
European Annals of Otorhinolaryngology, Head and Neck Diseases
Mattei, A., Amy de la Bretèque, B., et al. (2020).
European Annals of Otorhinolaryngology, Head and Neck Diseases, 137(3), 173-175.
This guideline provides preliminary recommendations on the management of swallowing disorders and recent dysphonia in patients with or suspected of having COVID-19.
French Society of Otorhinolaryngology, Head and Neck Surgery (SFORL; France)
<div>As a safety precaution, vocal rehabilitation should not be considered urgent in the current epidemic context. If the patient has already been treatment, it may continue via telepractice.</div>
<div>It is recommended that patients with swallowing disorders should only be assessed in cases of emergency that cannot be postponed and should only be conducted in a hospital environment. The following procedures should be considered very high risk for interpersonal contamination:</div>
<ul>
<li>clinical and flexible endoscopic swallowing assessments (especially since patients cannot wear a mask during food tests);</li>
<li>flexible endoscopies; </li>
<li>nasogastric tube insertions; and </li>
<li>videofluoroscopic swallowing exams. </li>
</ul>
<div>Clinical and flexible endoscopic assessments of swallowing are not routinely recommended because the patient is required to not wear a mask for tests involving food, because of the close proximity between the provider and the patient’s face, and because of high risk of projections of virus-laden droplets (e.g., during coughing, sneezing, spitting).</div>
<div>"In situations where urgent management of swallowing disorders is compulsory, as in some postoperative cases or in some patients with neurodegenerative diseases, tele-rehabilitation is preferable whenever it is technically possible and allowed by the current regulations" (p. 174).</div>
<div>When swallowing-related procedures cannot be postponed, it is recommended that the following personal protective equipment is provided and proper dressing and undressing is learned:</div>
<ul>
<li>protective glasses;</li>
<li>FFP2 (N95) mask;</li>
<li>cap;</li>
<li>gloves; and</li>
<li>gown.</li>
</ul>
<div>"Since we are currently in the COVID-19 pandemic phase, even asymptomatic patients can be infected and contagious, and as false negatives from coronavirus diagnostic tests are frequent, the same precautions should apply to all patients" (p. 174).</div>
<div>During the COVID-19 pandemic, laryngologists and speech pathologists may need to perform nasoendoscopies and laryngoscopies for recent dysphonia cases that cannot be postponed. If feasible, a teleconsultation is preferred.</div>
<div>If the team decides that an in-person consultation for recent dysphonia is necessary and a flexible endoscopy is not required nor is the patient likely to have COVID-19, it recommended that the patient and provider wear a surgical mask during the examination. If a flexible endoscopy is performed, the following personal protective equipment is required:</div>
<ul>
<li>head cap;</li>
<li>FFP2 (N95) mask;</li>
<li>protective glasses and, if possible, full-face protection with protective visor;</li>
<li>gloves; and</li>
<li>gown.</li>
</ul>
